Provider Network Growth & Negotiation Specialist

Doctors HealthCare Plans, Inc.; United States; On-site; USD 90,000 - 130,000; Full time

Job summary

Doctors HealthCare Plans, Inc. is seeking a Network Development professional in South Florida to develop, maintain and expand our provider network, including physician, medical group, ancillary, hospital and vendor agreements, in compliance with state and federal guidelines.

The role involves negotiating provider agreements, ensuring contract language compliance, credentialing, data accuracy and ongoing network optimization, with regular travel within the Miami/Dade region.

Qualifications

• Bachelor’s degree or equivalent in health services administration, business or related field.
• Excellent negotiation skills and ability to influence.
• Strong oral and written communication abilities.
• Bilingual English/Spanish preferred, with travel across the Miami/Dade region.

Responsibilities

• Ensure that contract language complies with State, CMS, AHCA and other regulatory guidelines.
• Use only company approved Provider Agreements.
• Obtain credential information for new providers and facilities and ensure completeness.
• Ensure completeness of all information in the agreements.
• Negotiate Provider Agreements for Primary Care Physician, Medical Specialty, Ancillary, and Hospital Services.
• Negotiate amendments to contracts.
• Maintain integrity of the provider database system as it relates to contracts.
• Perform claims and utilization research for re contracting existing network providers.
• Conduct comparative analysis of potential providers.
• Lead departmental projects as requested by VP Network Development/President/CEO.

Skills

Negotiation

Contract negotiation

Communication

Bilingual English/Spanish

Willing to travel

Regulatory knowledge

Education

Bachelor’s degree in health services administration, business or related field

Job description

Doctors HealthCare Plans, Inc. is seeking a Network Development professional in South Florida to develop, maintain and expand our provider network, including physician, medical group, ancillary, hospital and vendor agreements, in compliance with state and federal guidelines.

The role involves negotiating provider agreements, ensuring contract language compliance, credentialing, data accuracy and ongoing network optimization, with regular travel within the Miami/Dade region.